Clark Level IV and T1a??

Posted By
5/4/2011 8:19pm
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Replies: 2

My husband's initial biopsy path report is below... how can his Clark Level be VI but also have a Path Stage of T1a? What does this mean? (We have our first appt with the surg onco doc on Monday, and getting through this weekend is not going to be easy.)

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Malignant Melanoma

Thickness: 1.0 mm

Clark's Level: IV

Growth Phase: Vertical

Ulceration: Not Identified

Mitotic Rate: <1/mm2

Angiolymphatic Invasion: Not Identified

Features of Regression: Not Identified

Lymphocytic Host Response: Non-Brisk

Pathologic Stage: T1a

Microscopic:

Atypical Melanocytes are present within the epidermis and the papillary and reticular dermis. There is confluent melanocytic proliferation at the dejunction. Atypical spindle melanocytic proliferation is seen within deep dermis along with fibroplasia. Speail immunohistochemical stains melan A and S-100 helps to identify melanocytes and outline their distribution. Melana stain demonstrates pagetoid proliferation of melanocytes. Multiple levels are examined.

Comment:

The lesion extends to the base of the specimen. Reexcision for clear margins is recommended. 

Oops, Clark Level is FOUR (IV).

Janner - (5/4/2011 - 9:07pm)

Staging is incorrect.  He is stage IB, not 1A.  Understand, Clark's Level is quite subjective and because of the variability in determining the correct level, they've determined that Breslow depth is much more telling.  In your situation, what is more important than 1a/1b is the result of the SNB.  THAT will be the important staging procedure - stage 1 versus stage III.  Do NOT worry about the little details yet, it isn't really going to help you make it through the weekend.  Obsessive research just causes more anxiety...  Just wait until you have all the facts in place and THEN it makes more sense to get your bearings!

Best wishes,

Janner